Atrial Fibrillation Surgery in Australia: Are We Doing Enough?

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• Atrial fibrillation (AF) is a common comorbidity in patients undergoing cardiac surgery.
• Understanding the contemporary burden and treatment of AF in this population is crucial for guideline adherence and improved patient outcomes.

Purpose of the Study:

• To examine the current prevalence and treatment trends of atrial fibrillation (AF) in patients undergoing cardiac surgery in Australia and New Zealand.
• To compare contemporary practices with established guidelines for the surgical management of AF during cardiac surgery.

Main Methods:

• A 10-year retrospective analysis (2011-2021) of the Australian & New Zealand Society of Cardiac & Thoracic Surgeons National Cardiac Surgery Database.
• Inclusion of all adult cardiac surgery patients, with grouping based on the presence or absence of AF.
• Descriptive statistical analysis to assess demographics, comorbidities, AF incidence by surgery type, and trends in surgical AF treatments (ligation, ablation, or combined).

Main Results:

• The study identified 140,680 cardiac surgery patients, with AF present in 14% (21,077 patients), a higher incidence than previously reported.
• Patients with AF were older, more frequently female, and had higher NYHA dyspnea classifications and lower ejection fractions.
• AF incidence was higher in mitral valve surgery and combined CABG-valve surgery. Surgical treatments like ablation and ligation were used in only 11.90% of AF patients, with Cox-Maze IV ablation in 19.54% of those.

Conclusions:

• The prevalence of concomitant atrial fibrillation (AF) in cardiac surgery patients in Australia and New Zealand is higher than previously estimated.
• Despite strong recommendations and proven benefits, surgical interventions for AF, including left atrial appendage ligation and ablation, are significantly underutilized in this patient cohort.